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Comparing DSM-III-R and ICD-10 substance use disorders
1Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110.
Addiction (Abingdon, England)
|May 1, 1993
Summary
This study compared diagnostic systems for substance use disorders, finding agreement on dependence criteria but less on abuse and harmful use. Further evaluation of diagnostic system differences is needed.
Area of Science:
- Psychiatry
- Clinical Psychology
- Epidemiology
Background:
- The Diagnostic and Statistical Manual of Mental Disorders, 3rd edition, revised (DSM-III-R) was transitioning to the 4th edition (DSM-IV).
- Field trials for DSM-IV focused on various diagnostic aspects, including social/legal impacts, subtyping, and duration criteria.
- Comparisons between DSM-III, DSM-III-R, and the International Classification of Diseases, 10th Revision (ICD-10) were examined using data from DSM-IV Substance Use Disorders Field Trials.
Purpose of the Study:
- To compare diagnostic rates for substance use disorders across DSM-III, DSM-III-R, and ICD-10 (both old and new versions).
- To assess diagnostic agreement for alcohol, nicotine, cannabis, and cocaine use disorders.
- To evaluate the stability of diagnostic criteria across different systems, particularly for dependence versus abuse/harmful use.
Main Methods:
- Utilized data from the DSM-IV Substance Use Disorders Field Trials.
- Included diverse populations, notably African Americans and females, with varied diagnoses and use patterns.
- Compared diagnostic rates for dependence, abuse, and harmful use across DSM-III, DSM-III-R, and ICD-10 systems.
Main Results:
- Considerable agreement was found between DSM-III, DSM-III-R, and ICD-10 for substance dependence diagnoses.
- Less similarity was observed between the diagnostic systems when classifying substance abuse and harmful use.
- The study highlighted potential differences in the stability of diagnostic criteria for dependence compared to abuse and harmful use.
Conclusions:
- Diagnostic criteria for substance dependence appear more stable across different classification systems (DSM and ICD) than criteria for abuse or harmful use.
- Further research is necessary to fully understand and reconcile the differences and similarities between diagnostic systems for substance use disorders.
- The findings have implications for clinical practice, research, and the refinement of diagnostic criteria in future revisions.